Seshadri, Shreelata Rao and Kothai, Krishna
(2019)
Political and programmatic decentralization in India's health sector : insights from Karnataka.
Working Paper.
Azim Premji University, Bengaluru.
Abstract
While India has made progress in achieving important health sector goals, there is still a
long way to go. The Government of India has adopted decentralization or devolution with the objective
of promoting greater equity and supporting people-centred, responsive health systems. We report on a
study that problematizes the idea of strengthening health sector governance through decentralization
and that explores the intersection of the political goal of enhanced local-level autonomy and the
programmatic goal of more responsive health service delivery. The study examines the extent to which
both political and programmatic decentralization are functional at the village level; looks at the design
and objectives of decentralization at the village level; and considers whether sustained and supportive
capacity building can create the necessary conditions for more genuine de facto decentralization and
empowerment of village-level functionaries. Our methodology included semi-structured interviews
with village-level functionaries in two districts of Karnataka, based on which we designed an Action
Research to strengthen coordination and synergy between the functionaries responsible for political
and programmatic decentralization. We found that both political and programmatic decentralization
at the village level are at risk due to a lack of convergence between the political and programmatic
arms of the government. This is substantially due to problems inherent in the design of the
decentralization mechanism at the district level and below. Sustained capacity building can contribute
to the more effective application of decentralization mechanisms, but systemic issues regarding the
decentralization mechanisms need to be addressed alongside. We were also able to identify some spaces
where coordination between village-level functionaries is possible, and the steps that need to be taken
to build on this potential.
| Item Type: |
Monograph
(Working Paper)
|
| Authors: |
Seshadri, Shreelata Rao and Kothai, Krishna |
| Document Language: |
|
| Uncontrolled Keywords: |
Decentralization; National Health Mission; Village Health Sanitation and Nutrition
Committee (VHSNC); Community Health Worker (CHW); Karnataka health sector |
| Subjects: |
Technology > Medicine & health |
| Divisions: |
Azim Premji University - Bengaluru > University Publications > Working Paper |
| Full Text Status: |
Public |
| Related URLs: |
|
| Note: |
The working paper series aims at reflecting the range of work done across the Azim Premji Foundation, including the Field Institutes and the University, and disseminating this work to a broader audience. University faculty, members of Field Institutes of the Foundation as well as students graduating from the University may contribute to the series. The findings, interpretations and conclusions expressed in these papers are entirely those of the authors and do not necessarily represent the views of Azim Premji University. |
| URI: |
http://publications.azimpremjiuniversity.edu.in/id/eprint/2274 |
| Publisher URL: |
https://azimpremjiuniversity.edu.in/SitePages/pdf/... |
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